Provider Demographics
NPI:1154591238
Name:SULLIVAN, MORGAN SCOTT (RDO)
Entity type:Individual
Prefix:MR
First Name:MORGAN
Middle Name:SCOTT
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 WATER ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-3136
Mailing Address - Country:US
Mailing Address - Phone:508-788-0472
Mailing Address - Fax:508-877-0906
Practice Address - Street 1:778 WATER ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-3136
Practice Address - Country:US
Practice Address - Phone:508-788-0472
Practice Address - Fax:508-877-0906
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1726156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter